A 66-year-old man with a large secundum atrial septal defect (ASD) that had been repaired percutaneously 30 months previously with an Amplatzer ASD occluder (ASO) presented with fevers and Staphylococcus aureus bacteremia. Transesophageal echocardiography revealed a 1.5 × 1.5 cm mobile mass on the left atrial side of his ASO consistent with a vegetation. When the ASO was explanted, the left atrial side of the device was poorly endothelialized. In conclusion, the present report is the first description of late infective endocarditis in an adult with an ASO.
Case Description
A 66-year-old man with a large secundum atrial septal defect (ASD) that had been repaired percutaneously 30 months previously with a 32-mm Amplatzer ASD occluder (ASO; AGA Medical Corporation, Golden Valley, Minnesota) presented with a 1-week history of fevers up to 39°C. Blood and urine cultures grew methicillin-resistant Staphylococcus aureus in 3 different bottles, and he was started on vancomycin. Previously, he had known coronary artery disease, hypertension, diabetes mellitus, hyperlipidemia, and atrial fibrillation. His medical regimen included warfarin sodium, lisinopril, amlodipine, simvastatin, and insulin. There were no precordial murmurs. He had a small ulcer on his foot.
Transesophageal echocardiography revealed a 1.5 × 1.5 cm mobile mass on the left atrial side of his ASO consistent with a large vegetation ( Figure 1 ). The patient underwent removal of the ASO through a right atrial approach. The ASO was poorly endothelialized ( Figure 2 ), and a pocket of pus was present between the ASO and the atrial septum that was culture negative. Postoperatively, the patient received 6 weeks of vancomycin and recovered without further complications.
